Advances in Kidney Preservation Techniques and Their Application in Clinical Practice

Abstract

The use of cold preservation solutions to rapidly flush and cool the kidney followed by static cold storage in ice has been the standard kidney preservation technique for the last 50 y. Nonetheless, changing donor demographics that include organs from extended criteria donors and donation after circulatory death donors have led to the adoption of more diverse techniques of preservation. Comparison of hypothermic machine perfusion and static cold storage techniques for deceased donor kidneys has long been debated and is still contested by some. The recent modification of hypothermic machine perfusion techniques with the addition of oxygen or perfusion at subnormothermic or near-normothermic temperatures are promising strategies that are emerging in clinical practice. In addition, the use of normothermic regional perfusion to resuscitate abdominal organs of donation after circulatory death donors in situ before cold flushing is also increasingly being utilized. This review provides a synopsis of the different types of preservation techniques including their mechanistic effects and the outcome of their application in clinical practice for different types of donor kidney.

Shifting Paradigms for Suppressing Fibrosis in Kidney Transplants: Supplementing Perfusion Solutions With Anti-fibrotic Drugs

“…So far, great efforts have been put into the development of preservation solutions, each with the purpose of maintaining the viability of grafts. The benefits and drawbacks of various solutions are discussed in an extensive review written by Hosgood et al ( 55 ). Nonetheless, SCS suffers from several limitations, such as the fact that hypothermic and ischemic conditions as well as nutritional deficiencies do not fully stop cellular respiration or prevent the formation of metabolic waste products (e.g., lactate).…”

Sense and Sensibilities of Organ Perfusion as a Kidney and Liver Viability Assessment Platform

“…Nevertheless, hypothermic kidney perfusion has been reintroduced in clinical settings after it was shown to reduce the risk of DGF compared to static cold storage ( 13 ). Normothermic perfusion is being investigated in research settings with a first randomised trial underway ( 14 ).…”

Cold but not too cold: advances in hypothermic and normothermic organ perfusion

“…Nonetheless, even in conditions of reduced metabolism under cold conditions, there is an accumulation of metabolites leading to IRI. The increasing number of ECD and even the use of high numbers of DCD in several countries led to growing interest in the revival of a more physiologic environment during perfusion and storage [ 37 , 38 ]. This requires advanced technology, ideally with NMP from the donor hospital to the transplant center [ 39 ].…”